Superolateral Hoffa's Fat Pad Edema and Trochlear Sulcal Angle Are Associated With Isolated Medial Patellofemoral Compartment Osteoarthritis.

PURPOSE: To evaluate whether mediopatellar plica and knee morphometric measurements obtained from magnetic resonance imaging (MRI) studies are associated with isolated medial patellofemoral osteoarthritis in young adults. METHODS: MRI studies from 60 patients with isolated medial patellofemoral osteoarthritis and 90 control patients with normal knee MRI studies were reviewed. The presence of mediopatellar plica, the presence of edema in the superolateral aspect of Hoffa's fat pad and suprapatellar fat pad, quadriceps and patellar tendinosis, and axial and sagittal alignment of the patellar and trochlear morphology were assessed using MRI. The relationship between mediopatellar plica, alignment, or morphology and the presence of isolated medial patellofemoral osteoarthritis was evaluated using logistic regression. RESULTS: Superolateral Hoffa's fat pad edema (odds ratio [OR] = 3.4, P = .009) and decreased trochlear sulcal angle (OR = 0.95, P = .045) were associated with increased odds of isolated medial patellofemoral osteoarthritis. Decreased lateral patellar tilt (OR = 0.93, P = .087) and patellar tendinosis (OR = 4.13, P = .103) trended toward being associated with increased odds of isolated medial patellofemoral osteoarthritis but were not statistically significant. No significant association was seen between the presence of mediopatellar plica and medial patellofemoral osteoarthritis (OR = 0.95, P = .353). CONCLUSIONS: Medial patellofemoral osteoarthritis is associated with trochlear morphology and patellar alignment but not with mediopatellar plica.

Bibliometric Analysis of the Top 50 Most Influential Studies on Patellar Tendon Injury.

Background: There is a wide range of literature on patellar tendon injury, making it increasingly difficult to stay informed on the most influential studies in this field. It is essential to be familiar with the foundational articles of patellar tendon injury research to understand the current state of the literature and deliver high quality care. Purpose: To objectively identify the 50 most influential articles relating to patellar tendon injury and conduct a bibliometric analysis to identify key features of these articles. Study Design: Cross-sectional study. Methods: The Clarivate Analytics Web of Knowledge database was utilized to gather metrics on the 50 most cited articles on patellar tendon injury on June 27, 2022. The information extracted from each article included publication year, number of citations, author information, article type, level of evidence, country of origin, journal name, study focus, and industry influence. Results: The top 50 studies were cited a total of 8543 times and published between 1977 and 2015. The majority of articles were published after 2003, and the majority of citations were accrued after 2011. The most prevalent article types were cohort studies (n = 23), and the majority of studies were of evidence level 2 (n = 14) or 4 (n = 13). Australia and the United States (US) each published the most studies (n = 11). Only 4 (8%) studies focused on patellar tendon rupture, and 12 (24%) of the top 50 studies were associated with industry. Conclusion: The majority of the top 50 most influential articles in patellar tendon injury were published and accumulated citations in the past 10 to 20 years. Non-US countries, institutions, and journals published many of the top 50 studies, reflecting a global interest and commitment to research in this field. Patellar tendon rupture and surgical repair represents a minority of research in the top 50 studies and could be a point of growth in the future.

Effects of Physical Training on Physical and Psychological Parameters in Individuals with Patella Tendinopathy: A Systematic Review and Meta-Analysis.

The effectiveness of physical training on physical and psychological parameters in individuals with patella tendon myopathy has not been investigated in a systematic review and meta-analysis. The aim of the present study was to determine the effects of physical exercise interventions for measures of physical and psychological performance in subjects with patella tendon myopathy. A computerised systematic literature search was conducted in the electronic databases PubMed, Medline, and Web of Science from January 1960 to July 2020. Initially, 506 articles were identified for review of which eleven articles met the inclusion criteria. Our results revealed a small effect (weighted mean standardized mean difference (SMD) = 0.12; nine studies) of physical training on the psychological measure Victorian Institute of Sport Assessment-Patellar tendon scale and a medium effect (weighted mean SMD = 0.61; five studies) on the psychological measure visual analogue scale-both in favour of the intervention group. In contrast, a small effect (weighted mean SMD = -0.05; two studies) in favour of the control group was detected for the physical measure muscle power. Compared to the control condition, physical training seems to be an effective means to improve psychological but not physical parameters in individuals with patella tendon myopathy; although conclusions on the latter could have been biased by the small amount of eligible studies (n = 2). In addition, the predetermined cut-off value of ≥6 for the Physiotherapy Evidence Database scale score (i.e., assessment of methodological quality) was only achieved by six out of eleven studies. Thus, further research of high methodological quality is needed to verify whether there is or is not an effect of physical training on physical parameters in persons with patella tendon myopathy.

The association of patellar tendinosis with patellar maltracking and Hoffa's fat pad impingement: A case-control MRI study.

OBJECTIVES: To assess whether proximal or distal patellar tendinosis is associated with patellar maltracking parameters and superolateral Hoffa's fat pad impingement. METHODS: Institutional radiology database was reviewed for knee MRI scans performed over a 7-year period identifying cases of unequivocal patellar tendinosis, which were separated into 2 groups: proximal and distal tendinosis. For each group of proximal and distal patellar tendinosis, a control group of age and gender matched subjects was assigned. The scans were evaluated for patellar maltracking parameters including patellar alta, tibial tuberosity lateralization, trochlear dysplasia and lateral patellar tilt and for presence of superolateral Hoffa's fat pad edema. These parameters were compared between the case and control groups. RESULTS: Out of 9852 MRI scans, 94 patellar tendinosis cases were included (65 proximal and 29 distal tendinosis) and matched with equal numbers of controls. In the proximal patellar tendinosis group, more subjects had patella alta (22 versus 6, p = 0.0006), lateralization of tibial tuberosity (16 versus 7, p = 0.0495) and superolateral Hoffa's fat pad edema (16 versus 4, p = 0.0073) compared to the control group. In the distal patellar tendinosis group, there was no significant difference in the prevalence of any maltracking indicator or superolateral Hoffa's fat pad edema compared to the control group. CONCLUSION: Proximal patellar tendinosis was associated with patellar maltracking parameters including patella alta, lateralized tibial tuberosity and superolateral Hoffa's fat pad impingement. No association was demonstrated between distal patellar tendinosis and patellar maltracking indicators or superolateral Hoffa's fat pad impingement.

Differences in Physical and Psychological Parameters in Sub-Elite, Male, Youth Soccer Players with Jumper's Knee Following Physical Therapy Compared to Healthy Controls: A Longitudinal Examination.

PURPOSE/BACKGROUND: Many adolescent athletes suffer from jumper's knee (JK) over a long period of time and return to sports before symptoms are fully resolved. Current treatment methods may not reduce pain in the short term, especially not during a competitive season. The purpose of this study was to investigate differences in physical, psychological, and injury-/pain-related parameters in sub-elite male youth soccer players, who previously underwent physical therapy for JK compared to healthy controls (HC) over the course of a season. METHODS: All subjects were tested four times (start of the season [T1], 6 [T2], 16 [T3], and 20 [T4] weeks after the start of the season). Outcome measures included muscle power (drop jump, jump-and-reach), change of direction speed [CODS] (acyclic sprint), speed (tapping, 30-m linear sprint), endurance (Yo-Yo intermittent recovery test level 1), the Achievement Motives Scale (AMS) Sport, and injury-/pain-related data. Univariate analysis of variance was used to compare differences in variables between the two groups over the course of a soccer season. RESULTS: Over the season, the jumper's knee group (JK; 15.1 ± 0.8 yr) demonstrated significantly worse physical performance in CODS (to the left side: 1.37≤ Cohen's d ≤ 1.51 [T1-T4]; p < 0.001 / to the right side: 1.24 ≤ d ≤ 1.53 [T1-T4]; p < 0.001) and speed (0.48 ≤ d ≤ 1.26 [T1-T4]; p < 0.007) compared to healthy controls (HC; 15.0 ± 1.0 yr). Further, psychological parameters showed worse values in JK than in HC for the AMS Sport items "hope for success" and "fear of failure" that especially showed a significant difference at T1 (d = 0.65; p = 0.032 / d = 0.68; p = 0.027) and T2 (d = 0.50; p = 0.076 / d = 0.80; p = 0.012). Moreover, the JK group showed significantly higher incident rates for non-contact lower limb injuries (d = 0.69; p = 0.049) per 1,000 hours (i.e., practices/competitions), injury-related rest periods (d = 2.06; p = 0.043), and pain-related training interruptions (d = 1.35; p < 0.001). CONCLUSIONS: The observed findings imply that there are significant differences in physical and psychological performance of youth soccer players after physical therapy for JK compared to HC. When designing rehabilitation and/or training programs, as well as determining the point of return to sport the impact of the injury needs to be taken into account. LEVEL OF EVIDENCE: 1b.

Percutaneous ultrasonic tenotomy effectively debrides tendons of the extensor mechanism of the knee: A technical note.

BACKGROUND: Percutaneous ultrasonic tenotomy (PUT) is a minimally-invasive method of treating patellar tendinosis, but its immediate effect on tendon structure has never been studied. Given the crucial nature of the extensor mechanism of the knee, it is important to understand the procedure's effect on tendon structure prior to clinical implementation. The aim of this study was to analyze the tendon structure of the extensor mechanism of the knee after PUT in a cadaveric model. METHODS: Four fresh-frozen cadaveric specimens (two patellar and two quadriceps tendons) underwent PUT. The tendons were then sectioned and stained with hematoxilin & eosin (H&E). The sections were analyzed for a clear area of debridement. The area of debridement was calculated as an average of three measurements. RESULTS: All four tendons demonstrated a clear area of debridement limited to the treatment area without damaging any surrounding tissue. The area of debridement for the patellar and quadriceps tendons treated was 2.89 mm2, 1.5 mm2, 2.98 mm2 and 7.29 mm2, respectively. CONCLUSIONS: Percutaneous ultrasonic tenotomy effectively debrided the treatment area in all tendons without damaging surrounding tissue. Further work is needed to report clinical outcomes, assess the risk of post-procedure tendon rupture and define return-to-sport progression.

CURRENT CONCEPTS IN THE TREATMENT OF PATELLAR TENDINOPATHY.

Patellar tendon pain is a significant problem in athletes who participate in jumping and running sports and can interfere with athletic participation. This clinical commentary reviews patellar tendon anatomy and histopathology, the language used to describe patellar tendon pathology, risk factors for patellar tendinopathy and common interventions used to address patellar tendon pain. Evidence is presented to guide clinicians in their decision-making regarding the treatment of athletes with patellar tendon pain. LEVEL OF EVIDENCE: 5.

High-intensity stepwise conditioning programme for improved exercise responses and agility performance of a badminton player with knee pain.

OBJECTIVE: To examine the effect of a high-intensity stepwise conditioning programme combined with multiple recovery measures on physical fitness, agility, and knee pain symptoms of an injured player. DESIGN: A single case study. SETTING: University-based conditioning training laboratory. PARTICIPANTS: One 26-year-old male world-class badminton player (height, 190.0 cm; weight, 79.3 kg; left dominant hand; playing experience, 16 years; former world champion) with patellar tendinosis and calcification of his left knee. HIGH-CONDITIONING STEPWISE CONDITIONING PROGRAMME: The player received seven conditioning sessions over three weeks. During the programme, there was a gradual increase in training duration and load across sessions while cold therapy, manual stretches and massage were administered after each session to minimise inflammation. MAIN OUTCOME MEASURES: The training outcome was evaluated with three different testing methods: standard step test, badminton-specific agility test, and tension-pain rating. RESULTS: The conditioning programme reduced knee pain symptoms and improved actual performance and cardiopulmonary fitness during the agility task. The player was able to return to sport and compete within a month. CONCLUSIONS: A high-intensity stepwise conditioning programme improved the physical fitness while sufficient recovery measures minimised any possible undesirable effects and promoted faster return to elite level competition.

A multidisciplinary approach including the use of platelet-rich plasma to treat an elite athlete with patellar tendinopathy - a case report.

OBJECTIVE: Patellar tendinopathy affects a substantial proportion of athletes involved in jumping or kicking activities. Platelet rich plasma (PRP) injections may be a promising treatment used in conjunction with common traditional therapies. CLINICAL FEATURES: Patellar tendinopathy is often the result of repetitive or excessive overload on the patellar tendon. Activity modification, cryotherapy, eccentric exercises, shockwave therapy, and PRP have been indicated as treatment options during various stages of this condition. INTERVENTION AND OUTCOME: A 23 year old female, elite track and field athlete was managed for patellar tendinopathy with a combination of traditional therapeutic interventions as well as a PRP injection. This athlete returned to pre-injury level of competition six months post-injection. CONCLUSION: Emerging literature on PRP appears to be promising for patellar tendinopathy, however, it remains unclear which patients may benefit most and whether the stage of the disorder has an impact on the clinical outcome.

OBJECTIF: la tendinopathie rotulienne affecte une proportion considérable des athlètes dont les activités consistent à sauter ou à donner des coups de pied. Les injections de plasma riche en plaquettes (PRP) peuvent être un traitement prometteur lorsqu'utilisées avec les traitements traditionnels courants. CARACTÉRISTIQUES CLINIQUES: la tendinopathie rotulienne résulte souvent d'une surcharge répétitive ou excessive sur le tendon rotulien. La modification des activités, la cryothérapie, les exercices excentriques, la thérapie par ondes de choc et le PRP ont été indiqués comme des options de traitement au cours des différentes étapes de cette affection. INTERVENTION ET RÉSULTAT: une femme âgée de 23 ans, une athlète d'élite en athlétisme, a été traitée pour une tendinopathie rotulienne au moyen d'une combinaison d'interventions thérapeutiques traditionnelles ainsi qu'une injection de PRP. Cette athlète a regagné son niveau de compétitivité d'avant blessure six mois après l'injection. CONCLUSION: les documents scientifiques récents sur le PRP semblent être prometteurs pour la tendinopathie rotulienne, mais il est difficile de savoir quels patients pourraient en bénéficier le plus, et si le stade de l'affection a un impact sur le résultat clinique.

Heated lidocaine/tetracaine patch for treatment of patellar tendinopathy pain.

INTRODUCTION: The pain of patellar tendinopathy (PT) may be mediated by neuronal glutamate and sodium channels. Lidocaine and tetracaine block both of these channels. This study tested the self-heated lidocaine-tetracaine patch (HLT patch) in patients with PT confirmed by physical examination to determine if the HLT patch might relieve pain and improve function. METHODS: Thirteen patients with PT pain of ≥14 days' duration and baseline average pain scores ≥4 (on a 0-10 scale) enrolled in and completed this prospective, single-center pilot study. Patients applied one HLT patch to the affected knee twice daily for 2-4 hours for a total of 14 days. Change in average pain intensity and interference (Victorian Institute of Sport Assessment [VISA]) scores from baseline to day 14 were assessed. No statistical inference testing was performed. RESULTS: Average pain scores declined from 5.5 ± 1.3 (mean ± standard deviation) at baseline to 3.8 ± 2.5 on day 14. Similarly, VISA scores improved from 45.2 ± 14.4 at baseline to 54.3 ± 24.5 on day 14. A clinically important reduction in pain score (≥30%) was demonstrated by 54% of patients. CONCLUSION: The results of this pilot study suggest that topical treatment that targets neuronal sodium and glutamate channels may be useful in the treatment of PT.